565802472-9-6-2022-29-AS-KHEN-CJNREC-20220927125720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 09/06/2022
Date Signed: 09/06/2022 07:54:24 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220906125853

FACILITY NAME:	VENTURA GRAND CHATEAU		FACILITY NUMBER:	565802472
ADMINISTRATOR:	MARK DEN PERALTA		FACILITY TYPE:	740
ADDRESS:	5430 TELEGRAPH ROAD		TELEPHONE:	(805) 642-2567
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 37	DATE:	09/06/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Amy Phillips		TIME COMPLETED:	05:27 PM

ALLEGATION(S):

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Facility is in disrepair.
Facility is not providing a comfortable environment for the residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegations listed above. LPA arrived at the facility at 02:30PM and met with Medication Technician Amy Phillips. Administrator was unavailable during today's visit, but was contacted by telephone and designated Amy Phillips to sign today's reports. Entrance interview conducted.

During today's visit, LPA toured the facility with Medication Technician at 02:38PM, interviewed staff at 02:45PM and residents between 03:09PM and 03:20PM, and LPA reviewed and obtained copies of pertinent documents.

During facility tour, LPA noticed a broken sliding glass door in one of the resident rooms. Interview revealed the facility air conditioning has been broken since 08/29/2022. Repair estimate dated 09/01/2022

Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220906125853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 09/06/2022

NARRATIVE

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at 09:00AM was provided to LPA during the visit. During the visit, Medication Technician confirmed with Administrator the facility air conditioning has been broken since 08/29/2022. Email from Administrator indicates repairs are scheduled to be completed tomorrow 09/07/2022. The broken glass sliding door estimate was provided dated 08/31/2022 indicates once ordered, the glass will take about 10 business days to arrive. Although the resident has been temporarily relocated, LPA did observe broken glass inside the resident's room. Based on interviews and observation, the allegation that "Facility is in disrepair" is deemed SUBSTANTIATED at this time.

Also, during facility tour which began at 02:38PM, LPA took temperature readings in common areas as well as in resident rooms. LPA observed three (3) thermostats throughout the facility and the temperatures observed were as follows: 82 degrees Fahrenheit in the hallway near the resident rooms, 88 degrees Fahrenheit in the hallway/sitting area, and 89 degrees Fahrenheit in the activity room. LPA observed the temperature outside at 86 degrees Fahrenheit upon arrival to the facility and LPA confirmed that has been an excessive heat warning throughout the area issued at this time. LPA thermometer readings varied between 84 degrees and 88.8 degrees Fahrenheit. Based on observation, The allegation that "Facility is not providing a comfortable environment for the residents in care" is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted with Medication Technician Amy Phillips. Today’s reports and appeal rights were reviewed and provided to the Administrator via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220906125853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/07/2022 Section Cited CCR 87303(b)(2)	1 2 3 4 5 6 7	87303 (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C)...less than the outside temperature. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator indicated new air conditioning unit will be delivered and installed at 10:00AM on 09/07/2022. In the meantime, the medication technician will bring a personal portable air conditioning unit to ensure a comfortable temperature. Licensee will attempt to have additional units procured today also.
	8 9 10 11 12 13 14	Based on observation and interview, the temperatures inside the facility measured at 89 degrees Fahrenheit inside, which poses an immediate health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type A 09/07/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator indicated new air conditioning unit will be delivered and installed at 10:00AM on 09/07/2022. New sliding glass door was ordered last week and scheduled to be installed by 09/15/2022. Designeed agreed to provide proof of repaired items by 09/07/2022 (air conditioner) and broken sliding glass door by 09/16/2022.
	8 9 10 11 12 13 14	Based on observation and interview, the facility air conditioner broke on 08/29/2022 during a time of excessive heat warning, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC9099 (FAS) - (06/04)

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